Friday, 29 April 2016

Caesarean Awareness Month - Why caesareans are not easy

April is caesarean awareness month. And really I should have posted this at the beginning of the month but here we are right at the end as it's taken me an age to write! The arrival of Baby D was such an emotional time, writing about it really brought some of the feelings back and I could only write a bit at a time between bursts of tears. I thought that I’d come to terms with it but evidently I still have a little way to go yet.

Some people think having a c-section is the easy way to give birth. They couldn't be more wrong. It saddens me to hear some of the comments caesarean mums get about not pushing and not 'really' giving birth. Caesarean shaming is not ok.

All women and their experiences of caesareans are different but here's a bit about  the physical side of mine. Talking to other mums it seems that perhaps my recovery was worse/harder than others but I could be wrong. Aside from the feelings of failure and guilt from not birthing the 'natural way' the physical recovery was hard - I struggled, and still do from time to time. For a bit of background you can read my birth story here.

My main reason for not wanting a caesarean was my squeamishness. Up until Baby D's birth is never had any kind of surgery. I had a veruca removed when I was 5 and a milk tooth extraction when I was 6 but I don't think they count. The thought of needles in my spine, being cut open and stitches sent me into a panic. It had taken me a long time to get used to the idea that I'd have to give birth (vaginally) and as well as coming to peace with it I'd actually lost my fear. I did loads of research, antenatal classes, talking to friends and family, relaxation techniques and some natal hypnotherapy and upped my exercise to get myself fit for the birth. I was walking for an hour a day and swimming one kilometre every other day. I really felt ready. Then, at a growth scan I was told Baby D was in extended breech position but not to worry as 97% of babies turn before labour starts. Rather than resting on my laurels I did more research and did everything I could to get baby to turn. This involved lying backwards, upside down on the sofa (head on the floor, bum on the edge of the sofa, legs in the air) for 20 minutes, 3 times a day, moxibustion, head stands in a swimming pool, ecv. You name it, I tried it. Nothing worked. 

I reluctantly accepted that if Baby D didn't turn at the eleventh hour I'd have to have a caesarean and signed the paperwork at the hospital.

The rest you can read in my birth story but what I wasn't prepared for was the long, hard recovery.

After having had major abdominal surgery consisting of (in my case) a 6 inch incision through skin, fat, muscle, move your bladder then cut into the uterus the only pain killers you can take are paracetamol and ibuprofen. Sometimes this combination doesn't even get rid of a headache so I'm sure you can imagine that even after taking the maximum dose there is a considerable amount of pain. After a week of taking ibuprofen it started to irritate my tummy and I had to stop taking it as it caused severe cramping and diarrhoea. So I had to just take paracetamol which barely took the edge off.
Any other major abdominal surgery the patient is instructed to get lots of bed rest and usually has strong painkillers. With a caesarean you don’t get a break at all, you have to get on immediately after birth and look after another human being!

For the first 48 hours or so I genuinely couldn't move. I was physically incapable of turning onto my side let alone getting out of bed to pick up Baby D. Luckily I had a catheter so didn't have to get out of bed to wee. The problems came when my husband was sent home at 8pm on an evening from the hospital ward and I was left alone. I had one of those beeper things to call a nurse/midwife which twice slipped off the bed sheets and onto the floor. There was literally not a thing I could do. One time Baby D was in her crib (midwives kept removing her from my arms and putting her in the crib) needed her nappy changing and was screaming yet I couldn't get to get to pick her up. Believe me a tried. I thought my scar was going to split open and spill my innards over the floor. It hurt. A lot. Eventually an irritated looking health professional came to see why I wasn't dealing with my crying child. I explained what had happened but she had no sympathy whatsoever for my plight. She did however change the nappy and pass Baby D to me thank goodness.

48 hours after the birth I had to remove the dressing that was over the incision. Different women have different methods like stitches etc but mine was glued, then a large steristrip coving the whole area. What nobody knew, including myself, was that I was allergic to these dressings and my skin underneath had blistered. I was sent off to the shower to freshen up and instructed to remove the dressing. There was one mirror but it was at head height so I couldn't really see what I was doing and my massive belly hampered my view of the area so I had no idea that as I peeled the dressing away whilst tears of pain rolled down my cheeks that I was ripping away the blisters , leaving blood and raw flesh exposed. I still have the scars of those blisters nearly two years later.

Laying on the hospital bed on my back (sat up, lying down flat was agony) without being able to move for a long time hurt my coccyx. It was so uncomfortable and in the end I had bruising and a sore. It was about 6 weeks before that stopped hurting.

I'm a side sleeper but wasn't able to sleep on my side until Baby D was 3 weeks old due to the pressure on the incision as I turned. I had to pile up cushions and get as comfortable as possible but it was never particularly comfortable. In fact I couldn't even sleep flat until 2 weeks after the birth. 
Baby D slept in a sidecar cot but for weeks I was unable to turn or twist to pick her up so at every feed in the night my husband had to pass her to me.
I was also unable to bend down so I wasn't able to put on my own knickers or trousers for a good couple of weeks. Having assistance to put your knickers on is not much fun.

During surgery they pump you full of intravenous antibiotics to prevent infection taking hold. Obviously this is very necessary but it also kills all the good bacteria in your gut and a common result of this is thrush. And I'm talking thrush in the nipples and/or breasts which transfers to baby's mouth when breastfeeding. It hurts and hinders breastfeeding for both baby and mum and of course we got it. Baby D and I kept passing it back and forth to each other and it took 2 rounds of medication to get rid of.

You're not meant to lift anything heavier than your baby. Going upstairs on my own to go to the bathroom took forever. I was unable to carry my daughter up the stairs or even carry her and walk at the same time for the first few days. It was at least a fortnight before I could carry her up a flight of stairs. 

Having abdominal surgery gives you trapped wind. I don't mean what you might expect after beans on toast but what you might expect if you are 72 cans of beans in one sitting followed by it being sealed in with nowhere to escape. And it's not just in your gut but in your entire trunk from the knicker line through the rib cage and up to the boobs. I'd never had anything like it before so wasn't even aware that this horrible pain I was experiencing was in actual fact trapped wind. It wasn't until about a week later at a home visit with the midwife she examined my abdomen and was surprised to feel my abdomen and how bad it was. Luckily she suggested Deflatine which worked a treat and I had considerable relief within minutes of taking my first dose. Once that had subsided a few days later I felt so much better.

The area around the scar both goes numb and painful. The flesh in the tummy area loses sensation which feels uncomfortably weird but the scar hurts, itches and aches. You also get this horrible 'shelf' where the belly sort of overhangs the scar. And even after going back to pre-pregnancy weight my belly hasn't shrunk enough to go back to 'normal', I think I'll always have this tummy shelf and I'm not best pleased about it.
As the incision healed the scab would get tight and sore but I was advised not to put anything on it until my 6 week postnatal check. After that I was given the all clear to moisturise it (magic cream or Bio Oil) which helped a lot and made it more supple. I've been moisturising it every day since. If I forget to do it by the afternoon my scar becomes quite uncomfortable and this is nearly 2 years on.

I'm one of these women who lives in jeans, they are kind of part of my identity. I wear them 90% of the time but much to my disappointment I found that I could no longer wear my usual jeans. Where the flies are I'd find that they'd rub, especially when seated. After an hour or two of wearing them I'd be in so much discomfort I'd have to take them off. After 13 months of wearing jeggings and leggings I was finally able to wear normal jeans for most of a day again. However by the end of the day I still ache and feel sore from time to time.

The incision is underneath the baby bump just along the top of the pubic hairline. As the scar tissue grows and smooths out, the pubic hair (that they shave off before surgery) grows back through the scar and feels like tiny needles stabbing. Sometimes they get ingrown and get itchy too. I daren’t use any kind of hair removal along the scar as its raised from the skin and I don’t want to risk cutting or irritating it.

You’re not supposed to drive until 6 weeks after surgery. Some insurance policies state that you can’t drive until then too. It made me feel isolated not being able to go far alone. I wasn’t able to lift the buggy out of our front door and down the steps and wasn’t able to drive either which left me not able to do much. I did however master using a stretchy sling after a few weeks (a Close Caboo which didn’t wrap around the scar area) which helped me to get out and about alone.

So you see the physical side of caesarean recovery is not much fun at all. I’m now nearly two years postpartum and I still get twinges in the scar area. 
Another down side to having had a caesarean is that if I have another child I have two choices: another caesarean which quite frankly fills me with dread at having my scar opened again and going through the horrible recovery with two children to look after or a VBAC (vaginal birth after caesarean) which has a small risk of uterine rupture. But the percentage of babies breech at delivery is also very small…I wouldn’t be ‘allowed’ to give birth in a midwife led unit but would have to have a consultant led birth in a very medical setting which is the exact opposite of what I’d want. It’s kind of a rock and hard place situation.

So, please spare a thought for those mums who have been through caesareans. It’s not easy. It’s unlikely to have been the birth they would have chosen but they keep on going and doing the very best they can for their babies. The scars run deep both physically and mentally.

Dawn x

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